P1137 Prognostic value of intestinal ultrasound (IUS) in patients with Acute Severe Ulcerative colitis (ASUC) – A single center experience

Background

There is scarce evidence in the role of intestinal ultrasound (IUS) as a prognostic tool in patients with Acute Severe Ulcerative colitis (ASUC).

Methods

The study included hospitalized patients with ASUC that were assessed by IUS within 48 hours after intravenous corticosteroids (CS) initiation. Demographic characteristics of the patients, as well as response to corticosteroids, necessity of rescue therapy and/or urgent colectomy were recorded. Bowel wall thickness (BWT), modified Limberg score (mLimberg), loss of bowel stratification in left (LC), transverse (TC), and right (RC) colon, as well as the presence of mesenteric hypertrophy, enlarged lymph nodes, free fluid in peritoneal cavity and pneumatosis intestinalis were compared between CS responders and non-responders.

Results

Six patients participated in total (5 males) with a mean age of 73 years (±11) and a mean disease duration of 82 months (± 103). Three patients responded to CS. Among the non-responders, two underwent urgent colectomy and one received rescue therapy with Infliximab. The mean disease duration was lower in the non-responders. BWT was higher in LC in both patient groups but, RC BWT was statistically higher in non-responders group (6,3±0,3 vs 2,4±0,3, p=0,0001). Higher values of mLimberg score were observed in LC, however in non-responders, mLimberg was higher in every bowel segment. Total loss of bowel wall stratification in all colonic segments and free peritoneal fluid were recorded only in the non-responders group. Pneumatosis intestinalis and mesenteric hypertrophy were recorded mainly in the non-responders, whereas enlarged lymph nodes were found in both groups.

Conclusion

IUS is a useful non-invasive diagnostic tool for monitoring patients with ASUC and it may probably have a prognostic value regarding the patients’ response to CS. The thicker bowel wall in RC, the complete loss of bowel wall stratification, the presence of free peritoneal fluid and pneumatosis intestinalis are associated with CS failure. Larger studies including larger populations are essential in order to establish the role of IUS in patients with ASUC.

References

1.Ilvemark JFKF, Wilkens R, Thielsen P, et al. Early Intestinal Ultrasound Predicts Intravenous Corticosteroid Response in Hospitalised Patients With Severe Ulcerative Colitis. J Crohns Colitis. 2022;16(11):1725-1734. doi:10.1093/ecco-jcc/jjac083

2.Allocca M, Dell’Avalle C, Craviotto V, et al. Predictive value of Milan ultrasound criteria in ulcerative colitis: A prospective observational cohort study. United European Gastroenterol J. 2022;10(2):190-197. doi:10.1002/ueg2.12206